臺灣博碩士論文加值系統

目前臨床最常使用來診斷且非入侵性的心臟冠狀動脈檢查為多切面電腦斷層(Multi detector-computed tomography，MDCT) 心臟冠狀動脈電腦斷層（Coronary computed tomography arteriography，CCTA)檢查，具備了高時間解析度、低劑量以及高空間解析度的優點。本研究比較前瞻性心電圖門控的掃描模式與回溯性心電圖門控的掃描模式，做心臟冠狀動脈電腦斷層（CCTA)檢查。樣本收集，前瞻性掃描心電圖門控掃描技術樣本為40人，回溯性心電圖門控掃描技術樣本為50人，且將樣本分為Body mass index (BMI) 大於25和BMI小於25各使用120kV和100kV的管電壓做電腦斷層掃描，記錄關於使用的掃描技術和輻射劑量的數據。再由胸腔放射科醫師評估影像品質，結果得到了性別、年齡、身高都沒有發現顯著差異，CCTA有效輻射吸收劑量，前瞻性掃描技術2.77±0.76mSv，回溯性掃描技術9.64±3.34mSv；使用100kV管電壓4.35±2.47mSv，使用120kV管電壓6.95±4.8mSv。
結論：在選定的受檢者中，CCTA使用前瞻性心電圖門控的MDCT與回溯性的心電圖門控的CCTA大幅降低有效吸收輻射劑量(P＜0.001)，100kV管電壓比較起120kV管電壓有效吸收輻射劑量明顯降低(P＜0.001)。所以在心跳速率慢且穩定受檢者，使用前瞻性心電圖門控的256-MDCT的心臟冠狀動脈電腦斷層掃描，可以顯著降低有效吸收輻射劑量，為回溯性256-MDCT掃描的29%。另外掃描條件可視受檢者體型調控，如BMI較小可使用較少的管電壓。以本研究族群為例，相對於使用120Kv 管電壓回溯性心電圖門控，100kV管電壓前瞻性心電圖門控掃描技術有效吸收輻射劑量大幅降低約85％，而得到診斷品質相當之影像。

Introduction Regarding the advantages of high spatial and temporal resolutions and newly developed dose saving techniques, (MDCT) coronary computed tomography arteriography (CCTA) examination had become the most commonly used non-invasive diagnostic tools for coronary artery diseases. Our study was aimed to compare prospective ECG -triggered and retrospective ECG-gated scan modes for CCTA examinations.
Materials and methods Based on this retrospective study, total 40 and 50 subjects were enrolled in the prospective and retrospective group respectively. Following the guideline, tube voltage will select 120kV when body mass index (BMI) was greater than or equal to 25 and 100 kV for BMI less than 25. The image quality was evaluated by a senior thoracic radiologist.
Results Our results shows no significant difference between gender, age, or height between prospective and retrospective groups. CCTA effective radiation dose was 2.77±0.76mSv in prospective group, while retrospective technology 9.64±3.34mSv, the significant low dose in prospective group. The dose was 4.35±2.47mSv in 100kV group as compared to 6.95±4.8mSv in 120kV tube voltage.
Conclusion CCTA used in prospective ECG-triggered mode for selected subjects significantly reduced effective radiation dose as compared with retrospective ECG gated mode (P < 0.001). Therefore, in patients with slow and stable heart rate, using prospective ECG-triggered 256-MDCT scan significantly reduce the radiation. The dose was 29% of the retrospective group. In addition, the scanning conditions were subject to body size. For example, for a subject with smaller BMI, we can use less tube voltage. In this study, effective dose of 100kV tube voltage and prospective ECG triggered groups was compared with the retrospective mode and with 120Kv tube voltage group. Total 85% radiation dose was significantly reduced, while maintaining image quality was conducted.

指導教授推薦書.....................................................
口試委員審定書.....................................................
致謝...............................................................iii
中文摘要.......................................................... iv
英文摘要...........................................................vi
第一章 緒論 1
第一節、研究背景與動機 1
第二節、研究目的 5
第二章 文獻探討 6
第一節、臨床醫學影像的重要性 6
第二節、臨床使用多列式偵檢器之電腦斷層掃描儀(MDCT)應用心臟冠狀動脈疾病的狀況 7
第三節、前瞻性心電圖門控制掃描技術與回溯性心門控制掃描技術 8
第四節、臨床應用冠狀動脈電腦斷層掃描時降低輻射劑量的其他技術 10
第三章 材料與方法 12
第一節、研究設計及樣本收集 12
第二節、掃描參數 14
第三節、影像收集 15
第四節、輻射劑量 16
第四章 結果 19
第一節、前瞻性與回溯性的統計數據敘述 19
第二節、100kV與120kV的統計數據敘述 22
第三節、管電壓與掃描模式的成對比較 26
第五章 討論與研究限制 28
第一節、前瞻性與回溯性的不同掃描參數得到的輻射劑量比較 28
第三節、因為心率的高低穩定度而影響影像解析度與輻射劑量 30
第四節、前瞻性心電圖門控的256-MDCT的冠狀動脈電腦斷層掃描的優異性 30
第五節、前瞻性的256-MDCT的冠狀動脈電腦斷層ECG Triggering的一些缺點 31
第六節、研究限制 32
第七節、醫院的管理意涵 33
第八節、結論與未來展望 34
參考文獻 35

圖目錄
圖2 1、前瞻性心門控制掃描技術 9
圖2 2、傳統的回溯性心電圖門控制 10
圖3 1、螢幕上的心電圖訊號顯示 13
圖4 1、影像品質 25
圖4 2、管電壓與掃描模式的成對比較之統計圖 27

表目錄
表1 1衛生福利部民國105年十大死因統計表(衛生福利部, 2018) 1
表2 1、心臟冠狀動脈疾病在不同的檢查方式下的敏感度與特異(方玉瑶 et al., 2012) 7
表3 1、影像重組參數 16
表4 1、前瞻性與回溯性的數據統計表 21
表4 2、100kV與120kV的數據統計表 24
表4 3、管電壓與掃描模式的成對比較表 27

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